Challenging situations in partial nephrectomy

© 2016 IJS Publishing Group Ltd Although most partial nephrectomies are performed as primary procedures in the elective or semi-imperative setting on kidneys with relatively normal anatomy, this is not always the case. The indications for partial nephrectomy continue to expand and it is becoming particularly relevant in patients with single functioning kidneys, poor kidney function, anatomical anomalies and hereditary syndromes predisposing to multiple kidney cancers, such as Von Hippel-Lindau syndrome. These, along with previous abdominal su rgery, pose surgical challenges. In this article we offer advice as to how to tackle these unusual situations. An ability to master the whole range of indications will allow the modern upper renal tract surgeon to offer partial nephrectomy to a wider range of patients.Link_to_subscribed_fulltex

Discrepancy between radiological and pathological size of renal masses

<p>Abstract</p> <p>Background</p> <p>Tumor size is a critical variable in staging for renal cell carcinoma. Clinicians rely on radiological estimates of pathological tumor size to guide patient counseling regarding prognosis, choice of treatment strategy and entry into clinical trials. If there is a discrepancy between radiological and pathological measurements of renal tumor size, this could have implications for clinical practice. Our study aimed to compare the radiological size of solid renal tumors on computed tomography (CT) to the pathological size in an Australian population.</p> <p>Methods</p> <p>We identified 157 patients in the Westmead Renal Tumor Database, for whom data was available for both radiological tumor size on CT and pathological tumor size. The paired Student's <it>t</it>-test was used to compare the mean radiological tumor size and the mean pathological tumor size. Statistical significance was defined as <it>P </it>< 0.05. We also identified all cases in which post-operative down-staging or up-staging occurred due to discrepancy between radiological and pathological tumor sizes. Additionally, we examined the relationship between Fuhrman grade and radiological tumor size and pathological T stage.</p> <p>Results</p> <p>Overall, the mean radiological tumor size on CT was 58.3 mm and the mean pathological size was 55.2 mm. On average, CT overestimated pathological size by 3.1 mm (<it>P </it>= 0.012). CT overestimated pathological tumor size in 92 (58.6%) patients, underestimated in 44 (28.0%) patients and equaled pathological size in 21 (31.4%) patients. Among the 122 patients with pT1 or pT2 tumors, there was a discrepancy between clinical and pathological staging in 35 (29%) patients. Of these, 21 (17%) patients were down-staged post-operatively and 14 (11.5%) were up-staged. Fuhrman grade correlated positively with radiological tumor size (<it>P </it>= 0.039) and pathological tumor stage (<it>P </it>= 0.003).</p> <p>Conclusions</p> <p>There was a statistically significant but small difference (3.1 mm) between mean radiological and mean pathological tumor size, but this is of uncertain clinical significance. For some patients, the difference leads to a discrepancy between clinical and pathological staging, which may have implications for pre-operative patient counseling regarding prognosis and management.</p

Conversion Rate of Abstracts Presented at the Société Internationale d’Urologie into Peer-Reviewed Journal Publications

ObjectivesThe objective of this study was to determine the publication rate of abstracts presented at the Société Internationale d’Urologie (SIU) Congress and to analyse the characteristics associated with conversion to publication. MethodsAll abstracts from the 36th Congress of the Société Internationale d’Urologie were identified from the published 2016 abstract book. A PubMed search was performed using key words and author names to identify published journal articles corresponding with the presented abstracts. ResultsThe conversion rate of presented abstracts to publication by April 2022 was 30.73% (224 of 729). Many abstracts were published prior to presentation (35.27%, 79 of 224). The average time to publication of abstracts published post presentation was 16.88 months. The majority of abstracts were presented in urology-specific journals (66.96%, 150 of 224). Publishing journals had an average impact factor of 3.068 with Urology (18 of 224) and Worl d Journal of Urology (8 of 224) being the most common journals. Moderated ePosters had the highest conversion rate to publication (39.59%), whilst Unmoderated Videos had the lowest (11.32%). The abstract book assigned presentation topic groups to the moderated ePoster category; the most published abstract topic was sexual function (68.75%, 11 of 16). ConclusionsThe conversion rate of abstracts presented at the SIU to publications in peer-reviewed journals has shown improvement since previous reports; however, it remains lower than the rates associated with other major urological conferences. Almost 70% of presented abstracts do not convert to publication and this should be considered when incorporating abstract findings into clinical practic

Prevalence of the Clavien Dindo Classification in the Reporting of Surgical Complications in Major Urological Journals

ObjectivesTo review the methods of surgical complication reporting in urological journals, to determine the current utilisation of the Clavien Dindo classification, and to make comparison with previous reports over the last 10 years. MethodsA search was performed of all journal articles published in 5 major urological journals from January 2021 to April 2022, inclusive. All articles reporting surgical outcomes or complications were analysed. The current trend in complication reporting was compared with the results of the systematic search of the same 5 urological journals performed in 2012 by Yoon et al. ResultsA total of 137 articles were identified. The Clavien Dindo classification was the most common method used (105/137, 76.6%) followed by a text-based descriptive classification (31/137, 22.6%). Notably, the Clavien Dindo classification was the only standardised method used in any of the articles examined. The prevalence of Clavien Dindo classification usage is 76.6% in the articles analysed in our search compared with the 33.3% reported by Yoon et al. in their search of papers published in the same 5 urological journals between 2010 and 2012. ConclusionsThere has been a significant increase in the adoption of the Clavien Dindo classification in the reporting of complications in major urological journals in the last decade. This is a favourable trend which is likely in response to the ad hoc EAU Guidelines Panel 2012 recommendations. With more than 20% of journal articles still using descriptive text-based classifications, we should continue to encourage further implementation of standardised criteria, particularly the Clavien Dindo classification

Incidence and Mortality of Prostate Cancer in Commercial Airline Cockpit Crew: Systematic Review and Meta-Analysis

Commercial airline cockpit crew (CCC) are potentially exposed to occupational risk factors that may have detrimental health effects. However, available literature on prostate cancer (PCa) as a health outcome is conflicted. Therefore, this review of cohort studies aims to evaluate the incidence of and mortality from PCa in CCC based on studies published to date. PubMed, Medline, EMBASE and SCOPUS were searched from 1946 to April 2021. Cohort studies reporting standardized incidence ratios (SIR) and/or standardized mortality ratios (SMR) of PCa in CCC were included. Military, cabin crew and service personnel data were excluded. Independent data extraction was conducted, and study quality assessed. Standardized ratios were pooled using a fixed effects model and expressed with 95% confidence intervals. 75 studies were assessed for eligibility from which 6 involving 129 374 licensed CCC were included in the final analysis: Two reported incidence only, 1 incidence and mortality and 3 reported mortalities only. The pooled SIR for PCa in CCC was 1.41 (95% CI 1.17 to 1.71) with moderate heterogeneity (I2 = 53%) however, the pooled SMR was not statistically significant (1.08; 95% CI 0.94 to 1.24) also with moderate heterogeneity (I2 = 70%). The available evidence shows that CCC are at a higher risk of developing PCa but there is no evidence to suggest a similarly higher risk of death from the disease. The effect of early detection through PSA testing in this cohort is unclear. Occupational exposure to radiation and sleep disturbance may play a role, but clear evidence of additional risk is lacking. Our review indicates that most evidence is dated and to confidently assess contemporary health outcomes of CCC, further research is required